Baseline Montreal Cognitive Assessment Score Research Articles

Incident Infarcts in Patients With Stroke and Cerebral Small Vessel Disease: Frequency and Relation to Clinical Outcomes.

Factors associated with cerebral small vessel disease (SVD) progression, including incident infarcts, are unclear. We aimed to determine the frequency of incident infarcts over 1 year after minor stroke and their relation to baseline SVD burden, vascular risks, and recurrent stroke and cognitive outcomes. We recruited patients with lacunar or nondisabling cortical stroke. After diagnostic imaging, we repeated structural MRI at 3-6 monthly intervals for 12 months, visually assessing incident infarcts on diffusion-weighted imaging or FLAIR. We used logistic regression to determine associations of baseline vascular risks, SVD score, and index stroke subtype with subsequent incident infarcts. We assessed cognitive and functional outcomes at 1 year using Montreal Cognitive Assessment (MoCA) and modified Rankin scale (mRS), adjusting for baseline age, mRS, MoCA, premorbid intelligence, and SVD score. We recruited 229 participants, mean age 65.9 (SD 11.1). Over half of all participants, 131 of 229 (57.2%) had had an index lacunar stroke. From baseline to 1-year MRI, we detected 117 incident infarcts in n = 57/229 (24.8%) participants. Incident infarcts were mainly of the small subcortical (86/117 [73.5%] in n = 38/57 [66.7%]) vs cortical infarct subtype (n = 19/57 [33.3%]). N = 39/57 participants had incident infarcts at 1 visit; 18 of 57 at 2 or more visits; and 19 of 57 participants had multiple infarcts at a single visit. Only 7 of 117 incident infarcts corresponded temporally to clinical stroke syndromes. The baseline SVD score was the strongest predictor of incident infarcts (adjusted odds ratio [OR] 1.87, 95% CI 1.39-2.58), while mean arterial pressure was not associated. All participants with incident infarcts were prescribed an antiplatelet or anticoagulant. Lower 1-year MoCA was associated with lower baseline MoCA (β 0.47, 95% CI 0.33-0.61), lower premorbid intelligence, and older age. Higher 1-year mRS was associated with higher baseline mRS only (OR 5.57 [3.52-9.10]). Neither outcome was associated with incident infarcts. In the year after stroke in a population enriched for lacunar stroke, incident infarcts occurred in one-quarter and were associated with worse baseline SVD. Most incident infarcts detected on imaging did not correspond to clinical stroke/transient ischemic attack. Worse 1-year cognition and function were not associated with incident infarcts.

Using Dual-Target rTMS, Single-Target rTMS, or Sham rTMS on Post-Stroke Cognitive Impairment.

The clinical application of 10 Hz repetitive transcranil magnetic stimulation (rTMS) remains limited despite its demonstrated effectiveness in enhancing cortical excitability and improving cognitive function. The present study used a novel stimulus target [left dorsolateral prefrontal cortex + primary motor cortex] to facilitate the enhancement of cognitive function through the bidirectional promotion of cognitive and motor functions; Methods: Post-stroke cognitive impairment patients (n = 48) were randomly assigned to receive either dual-target, single-target, or sham rTMS for 4 weeks. Before and after 4 weeks of treatment, participants were asked to complete the Montreal Cognitive Assessment (MoCA) test, the Modified Barthel Index (MBI), the Trail-making Test (TMT), and the Digital Span Test (DST). In addition, the levels of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) in serum were also measured. After adjusting for pre-intervention (baseline) MoCA scores, the post-intervention MoCA scores varied significantly. After post-hoc analysis, differences existed between the post-treatment scores of the dual-target rTMS group and the sham rTMS group (the experimental group scores were significantly higher), and between those of the dual-target rTMS group and the single-target rTMS group (the dual-target rTMS scores were significantly higher). The serum VEGF levels of the dual-target rTMS group were significantly higher those that of the sham rTMS group. The present study presented data showing that a dual-target rTMS therapy is effective for Post-stroke cognitive impairment (PSCI). The stimulation exhibited remarkable efficacy, suggesting that dual-target stimulation (left dorsolateral prefrontal cortex+motor cortex (L-DLPFC+M1)) holds promise as a potential target for TMS therapy in individuals with cognitive impairment after stroke. No: ChiCTR220066184. Registered 26 November, 2022, https://www.chictr.org.cn.

Cognitive Outcomes following Virtual Reality Rehabilitation in Patient with Traumatic Brain Injury: A Prospective Randomized Comparative Study

Abstract Introduction Comprehensive rehabilitation is essential to enhance the quality of life and cognitive performance of traumatic brain injury (TBI) survivors. Virtual reality (VR) has emerged as a promising tool for TBI rehabilitation due to its ability to provide an engaging and tailored environment. Materials and Methods This was a randomized comparative study conducted at tertiary hospital and included individuals aged between 18 and 60 with mild-to-moderate cognitive impairment due to TBI. The participants were divided into a case group receiving intensive VR rehabilitation and a control group receiving standard care. Cognitive assessments were conducted before and after treatment, and during follow-up. Results VR rehabilitation demonstrated significant improvements in cognitive function. The VR group exhibited remarkable progress in the Montreal Cognitive Assessment (MoCA), Tower of London (TOL), and Trail Making Test (TMT) scores. Baseline MoCA, TOL, and TMT scores (mean value) of case group 16.5, 11.75, and 14.05 and for control group 17, 10, and 13 were respectively. All the parameters of case group improved at the time of discharge (MoCA: 24.3, TOL: 22, TMT: 27.5) and in follow-up (MoCA: 28.5, TOL: 32.5, TMT: 42.07) as compared with control group at discharge (MoCA: 19, TOL: 13, TMT: 17) and in follow-up (MoCA: 21, TOL: 15, TMT: 19), which shows significant improvement in case group (p < 0.001) as compared with control group. Conclusion VR rehabilitation significantly improves cognitive outcomes in TBI patients. It has the potential to be a significant tool in TBI rehabilitation.

Abstract TP38: Cognitive Decline After Stroke Correlates With Small Vessel Disease and Race

Introduction: An Asian study found 30% of patients showed a cognitive decline measured by Montreal Cognitive Assessment (MoCA) score one year after stroke. There is limited US data on this subject. We investigated 1) decline rate in MoCA one year post-stroke 2) racial differences in baseline MoCA post-stroke and 3) if racial differences in small vessel disease (SVD) correlated with the decline in MoCA. Methods: MoCA was assessed in the PREMIERS trial (NCT#02541032) at baseline and one year after index stroke. Sub-scores for each MoCA domain were combined into a total score. The Fazekas scale was used to rate white matter signal abnormalities on patient MRI FLAIR images at baseline. Patients were categorized by total, deep white matter (DWM), and periventricular white matter scores. They were then sub-categorized into none/mild or moderate/severe groups. A one year cognitive decline was defined as a decline in MoCA scores by ≥2 points. Results: Of 280 patients, 30.4% had a ≥2 decline in MoCA score, with no significant difference between AA and white (29.4% vs. 32.9%, p=0.57). However, AA patients had lower baseline total MoCA scores (20.4±4.6 vs. 22.6±3.9, p<0.001), visuospatial/executive (3.1±1.5 vs. 3.7±1.3, p<0.001), naming (2.5±0.7 vs. 2.8±0.4, p=0.001), and attention (4.2±2.1 vs. 4.9±1.9, p<0.001) sub-scores. Overall, baseline MoCA was lower in patients with moderate/severe total Fazekas scores (20.1±5.0 vs. 21.6±4.2, p=0.015) and DWM sub-scores (20.1±5.2 vs. 21.4±4.2, p=0.048). In AA, baseline MoCA remained lower in patients with moderate/severe total Fazekas scores (19.6±5.1 vs. 21.0±4.2, p=0.039) and DWM sub-scores (19.4±5.5 vs. 21.0±4.1, p=0.055). This was contrary to White patients with moderate/severe total Fazekas scores (22.3. ±4.4 vs. 23.0±3.9, p=0.50) and DWM sub-scores (23.1±2.3 vs. 22.7±4.4, p=0.73). Conclusion: We report that 30.4% of patients in this US-based study showed a decline in MoCA score one year post-stroke, which aligns with a similar study conducted in Asia. A significant association was found between the AA race and lower baseline total MoCA score compared to white patients. Moderate/severe total and DWM Fazekas scores are also significantly associated with lower baseline MoCA scores, a finding specific to AA patients.

Baseline serum brain-derived neurotrophic factor association with future cognition in community-dwelling older adults undergoing annual memory screening

ABSTRACT Objectives It has been shown that peripheral measures of brain-derived neurotrophic factor (BNDF), an important neurotrophin instrumental to the biology of learning, may contribute to predicting cognitive decline. However, the two primary forms of BDNF, mature (mBDNF) and pro (proBDNF), and how they contribute to cognition longitudinally has not been well studied. Methods Eighty-two older adults (average age 72.2 ± 6.4 years) provided blood samples at two time points separated on average by 4.2 years while participating in an annual memory screening that included the MoCA (Montreal Cognitive Assessment) and GDS (Geriatric Depression Scale). Both mBDNF and proBDNF from serum were quantified at each time point. Whole blood samples were genotyped for APOE and BDNF Val66Met. Results Using logistic regression analysis controlling for age, sex, baseline MoCA score, APOE, and BDNF, higher baseline mBDNF was associated with subjects whose screening score was near maximum or maximum (as defined by MoCA score of 29 or 30) at the second collection visit. APOE was a significant contributing factor; however, BDNF Val66Met was not. Using a similar logistic regression analysis, baseline proBDNF was not found to be associated with future cognition. Discussion This study further supports that mBDNF measured in the serum of older adults may reflect a protective role while proBDNF requires further investigation.

Use of cortical volume to predict response to temporary CSF drainage in patients with idiopathic normal pressure hydrocephalus.

Temporary drainage of CSF with lumbar puncture or lumbar drainage has a high predictive value for identifying patients with suspected idiopathic normal pressure hydrocephalus (iNPH) who may benefit from ventriculoperitoneal shunt insertion. However, it is unclear what differentiates responders from nonresponders. The authors hypothesized that nonresponders to temporary CSF drainage would have patterns of reduced regional gray matter volume (GMV) as compared with those of responders. The objective of the current investigation was to compare regional GMV between temporary CSF drainage responders and nonresponders. Machine learning using extracted GMV was then used to predict outcomes. This retrospective cohort study included 132 patients with iNPH who underwent temporary CSF drainage and structural MRI. Demographic and clinical variables were examined between groups. Voxel-based morphometry was used to calculate GMV across the brain. Group differences in regional GMV were assessed and correlated with change in results on the Montreal Cognitive Assessment (MoCA) and gait velocity. A support vector machine (SVM) model that used extracted GMV values and was validated with leave-one-out cross-validation was used to predict clinical outcome. There were 87 responders and 45 nonresponders. There were no group differences in terms of age, sex, baseline MoCA score, Evans index, presence of disproportionately enlarged subarachnoid space hydrocephalus, baseline total CSF volume, or baseline white matter T2-weighted hyperintensity volume (p > 0.05). Nonresponders demonstrated decreased GMV in the right supplementary motor area (SMA) and right posterior parietal cortex as compared with responders (p < 0.001, p < 0.05 with false discovery rate cluster correction). GMV in the posterior parietal cortex was associated with change in MoCA (r2 = 0.075, p < 0.05) and gait velocity (r2 = 0.076, p < 0.05). Response status was classified by the SVM with 75.8% accuracy. Decreased GMV in the SMA and posterior parietal cortex may help identify patients with iNPH who are unlikely to benefit from temporary CSF drainage. These patients may have limited capacity for recovery due to atrophy in these regions that are known to be important for motor and cognitive integration. This study represents an important step toward improving patient selection and predicting clinical outcomes in the treatment of iNPH.

Brief, Interoceptive Exposure Focused Treatment for Anxiety in Older Adults

AbstractBackgroundOlder adults with Mild Cognitive Impairment (MCI), Alzheimer’s disease (AD) and related dementias, and their care partners often experience high levels of anxiety. This not only diminishes their quality of life but also serves as a marker for earlier onset of ADRD symptoms for individuals experiencing MCI. Moreover, there is no well‐established treatment for those with MCI/mild AD. Anxiety sensitivity (AS) is a mechanism central to the genesis and maintenance of anxiety psychopathology that exacerbates the experience of somatic and emotional sensations, leading to increased distress. Brief, computerized, mechanism‐focused interventions have been shown to effectively reduce AS. This study sought to evaluate the acceptability and efficacy of a brief AS focused intervention in older adults with probable MCI including a repeated interoceptive exposure component and the participation of a care partner.MethodParticipants (N = 16) were recruited from the community varied in age from 65 to 81 (M = 72.44; SD = 4.83). Eligible participants enrolled in an open trial consisting of a 2‐hour intervention focused on interoceptive exposure (systematic exposure to anxiety and stress symptoms to achieve habituation). All participants completed a brief cognitive assessment, AS measures pre‐ and post‐intervention, and acceptability measures post‐intervention.ResultAverage baseline Montreal Cognitive Assessment scores were 24.25 (SD = 3.24; Range = 19‐29), which is generally indicative of MCI. Paired samples t‐tests were conducted to examine changes in total ASI‐3 scores pre‐ to post‐intervention. Despite the relatively small sample, we observed statistically significant reductions in ASI‐3 total scores with a large effect size (Δ = 4.38, Hedge’s g = .80, p&lt;.01). Additionally, the intervention was highly acceptable with 100% of participants completing the intervention and rating the quality of the intervention as good or excellent.ConclusionThis study provides encouraging evidence that brief interventions can successfully target risk mechanisms of anxiety in older adults with probable MCI. The favorable acceptability of the intervention suggests that it would be well‐received by both those with MCI and mild AD. Future research should examine this intervention in randomized‐clinical trials and study its effects longitudinally to understand how decreases in AS persist over time and relate to cognitive outcomes.

Relationship between serum apolipoprotein B levels and depressive symptoms in elderly Chinese patients with mild cognitive impairment: A large-scale cross-sectional and five-year follow-up study

BackgroundPatients with mild cognitive impairment (MCI) often have depressive symptoms. The purpose of this study was to investigate the effects of depressive symptoms on lipid metabolism and future cognitive function in patients with MCI. MethodsA total of 1014 patients with MCI were included. Their demographic data, clinical data, and lipid parameters were collected. Meanwhile, they also completed a series of scale assessments, including Geriatric depression scale (GDS), Ability of Daily Living (ADL), Montreal cognitive assessment (MoCA) and Block Design Test (BDT). Then these patients were also followed for five years. ResultsPatients with depressive symptoms had lower serum apolipoprotein B (ApoB) levels, lower BDT scores and higher ADL scale scores. Correlation analysis showed that GDS was significantly associated with BDT and ADL. Moreover, logistic regression analysis found that ApoB was associated with depressive symptoms. Cox regression analysis showed that only baseline MoCA scores could predict the risk of future MCI transition to dementia. ConclusionsOur results suggest low serum ApoB levels may be associated with depressive symptoms in patients with MCI. However, depressive mood or lipids alone may not predict the risk of MCI transition to dementia.

Long-term neurological complications in COVID-19 survivors: study protocol of a prospective cohort study (NeurodegCoV-19)

BackgroundEvidence suggests an association between SARS-CoV-2 infection and worse performance on cognitive tests, and a higher risk of Parkinson’s disease (PD) and dementia up to 6 and 12 months after...

Association between peripheral adaptive immune markers and disease progression in Parkinson's disease.

The pathogenesis of PD has not been fully elucidated, but recent studies have shown that the adaptive immune system may play a role in the pathology of PD. However, there is a lack of longitudinal studies exploring the relationship between peripheral adaptive immune indicators and the rate of disease progression in PD. We included early PD patients with disease duration < 3years and assessed the severity of clinical symptoms and peripheral adaptive immune system indicators (CD3+, CD4+, CD8+ T lymphocyte subsets, CD4+:CD8+ ratio, IgG, IgM, IgA, C3, C4) at baseline. Clinical symptoms were followed up every year. We used the Unified Parkinson's Disease Rating Scale (UPDRS) to assess the disease severity and the Montreal Cognitive Assessment (MoCA) to assess global cognitive function. A total of 152 PD patients were eventually included. The linear mixed model showed no significant association between baseline peripheral blood adaptive immune indicators and baseline MoCA scores or UPDRS part III scores. A higher baseline CD3+ lymphocyte percentage was associated with a slower rate of decline in MoCA scores. Baseline immune indicators were not associated with the rate of change of the UPDRS part III scores. The subset of peripheral T lymphocytes was related to the rate of cognitive decline in early PD patients, suggesting that the peripheral adaptive immune system may be involved in the process of cognitive decline in early PD.

Pre‐stroke chronic cerebrovascular disease is a major determinant for response to structured cognitive rehabilitation following acute ischemic strokes

AbstractBackgroundPost Stroke Cognitive Impairment (PSCI) is seen in 40‐60% of patients with ischemic strokes. Response of patients with PSCI to structured cognitive rehabilitation is not clearly understood. We evaluated baseline variables that predict response to an eight‐week non‐pharmacological intervention among patients with mild strokes and compared the responses to non‐pharmacological intervention among acute stroke patients with and without chronic cerebrovascular disease (CVD).Method139 ischemic stroke survivors were recruited from a tertiary hospital in Singapore. All patients underwent an eight‐week structured group cognitive rehabilitation programme (Figure 1). Baseline, immediate post‐intervention (Immediate‐PI) and 6‐month post intervention (6‐month‐PI) global cognitive and quality of life (QOL) outcomes were assessed by Montreal Cognitive Assessment (MoCA) and Dementia‐Quality of Life (DemQOL). Regression analyses evaluated the influence of cognitive rehabilitation on outcomes.ResultThe mean age of subjects were 63.6 (±9.66) with 64.4% males. Baseline MoCA and DemQOL scores were 23.30 (±3.05) and 79.16 (±14.80). At Immediate‐PI, patients with more past strokes (p = 0.033) and severe white matter hyperintensities (WMH) (p = 0.048), benefited less on global cognitive outcome (Table 1). Male patients (p = 0.074) and patients with more severe WMH (p = 0.048) benefited less on QOL outcome (Table 2). At 6‐month‐PI, patients with microhemorrhages in the deep region (p = 0.002) were less likely to sustain cognitive improvement. With every past stroke experienced, patients were less likely to experience an improvement in MoCA score Immediate‐PI (OR = 2.17, 95% CI: 0.980‐4.813, p = 0.056). with severe WMH were less likely to experience an improvement in MoCA scores Immediate‐PI compared to baseline (OR = 2.13, 95% CI: 1.04‐4.38, p = 0.039). Finally, patients with microhemorrhages in the deep region were less likely to retain the improvements in MoCA at 6‐month‐PI (OR = 19.93, 95% CI: 1.04‐384, p = 0.047)ConclusionPre‐stroke CVD were associated with worse cognitive and QoL outcomes post cognitive rehabilitation. Understanding factors that result in poor response to rehabilitation will allow clinicians to better select stroke survivors for cognitive rehabilitation. Future research could build on these findings and allocate more resources to these at‐risk groups for post‐stroke care, therefore reducing the global burden of stroke and ensuring a better QOL for stroke survivors.

PO-02-093 IMPACT OF ABLATION OUTCOME ON COGNITIVE FUNCTION IN PATIENTS WITH ATRIAL FIBRILLATION

Emerging evidences suggest increased risk of all forms of dementia in patients with atrial fibrillation (AF) even in the absence of overt stroke. Cerebral hypoperfusion and the risk of cerebrovascular micro- and macro-embolism are plausible explanations for the predisposition for cognitive decline in AF. We evaluated the impact of ablation outcome on cognitive function in AF patients. Consecutive patients receiving AF ablation were screened prior to the procedure and consenting subjects were enrolled in our COGNITION registry (NCT01816308). Cognitive function was assessed using the Montreal cognitive assessment (MoCA) survey. Patients with baseline MoCA score of ≤17 were excluded from the analysis. In this survey, with a scale of 0-30, 27-30 is considered normal cognition, 18-26 as mild cognitive impairment (MCI) and ≤ 17 as dementia. Post-ablation MoCA survey was conducted at 1 year. Change in MoCA score of 1.7 points was considered clinically significant. Standard institutional protocol was followed to monitor patients for arrhythmia recurrence at quarterly interval during the 1-year follow-up period. A total of 576 AF patients receiving their first catheter ablation were enrolled in the COGNITION registry. At 1 year, 191 (33.1%) patients experienced recurrence (group 1) and 385 remained arrhythmia-free off-drugs (group 2). Baseline characteristics of the study population is given in table 1. Baseline MoCA score was 20±3.7 in group 1 vs 19.2±3.8 in group 2 (p=0.09). At 1-year follow-up, mean MoCA score was significantly lower from the baseline score in group 1 (16.05±4.4, p<0.001) and higher (21.7±2.4, p<0.001) in group 2. Mean change in the MoCA score was -5.08±4.3 and 2.9±2.6 in group 1 and 2 respectively (p<0.001). In this series, significant change in cognitive function was observed following catheter ablation; MoCA score declined substantially in patients experiencing recurrence and improved in those that remained arrhythmia-free.

427 Cognitive Function and Catastrophizing in the Adult Deformity Population: Single Center Series of 111 Patients

INTRODUCTION: Baseline cognitive impairment (CI) in adult spinal deformity (ASD) pts is unknown and may affect how they report PROMs/experience pain. Goal of this study was to determine baseline CI prevalence and how it’s related to PROMs/pain catastrophizing. METHODS: Single center prospective study. PROMs included the Montreal Cognitive Assessment(MOCA), Pain Catastrophizing Scale (PainCS), back pain numerical score, Oswestry Disability Index(ODI), and Scoliosis Research Society-22 (SRS22) questionnaires. Pts were stratified by normal cognition (MOCA scores 26-30), mild CI (MOCA 18-25), moderate CI (MOCA 10-17) and Severe CI (MOCA &lt;10). PainCS (higher = more catastrophizing) has total scor e(T,max = 52) and 3 subdomains (Rumination [R,max = 16], Magnification [M,max = 12], Helplessness [H,max = 24]). Comparisons were made between pts with normal (NORM) and any type of CI (CI) as well as correlations between MOCA and PROMS. MOCA scores were compared postop. RESULTS: Total 111 pts enrolled (mean age 64.1 ± 9.8 yrs, 57.5% F). Mean baseline MOCA score was 25.0±3.0 (mild CI, range 14-30), 59/111(53.1%) had mild/moderate CI. No severe CI. CI pts had significantly higher mean baseline PainCS-T, PainCS-R, and PainCS-M scores than NORM. CI pts had significantly worse baseline ODI (55.2 ± 15 vs 47.9 ± 14.4, p = 0.02) but better self-reported SRS Mental score (3.3 ± 1 vs 2.7 ± 0.8, p = 0.004) than NORM. Lower baseline MOCA scores significantly correlated with higher baseline ODI(r=-0.24,p=0.015), SRS Mental (r = -0.21, p = 0.037), current back pain (r = -0.26, p=0.006), and PainCS-R (r=-0.38, p&lt;0.001), PainCS-M(r = -0.37, p &lt; 0.001), PainCS-H (r = -0.27, p = 0.004), PainCS-T(r = -0.36, p &lt; 0.001). Mean pre/postop MOCA scores were not significantly different (p &gt; 0.05). CONCLUSIONS: Baseline CI is frequent in ASD pts and associated with higher baseline pain/disability and pain catastrophizing compared to ASD pts with normal cognition. The CI persists postoperatively.

Predictors of cognitive impairment in newly diagnosed Parkinson's disease with normal cognition at baseline: A 5-year cohort study.

Cognitive impairment (CI) is a substantial contributor to the disability associated with Parkinson's disease (PD). We aimed to assess the clinical features and explore the underlying biomarkers as predictors of CI in patients with newly diagnosed PD (NDPD; less than 2 years). We evaluated the cognitive function status using the Montreal Cognitive Assessment (MoCA) and a battery of neuropsychological tests at baseline and subsequent annual follow-up for 5 years from the Parkinson's Progression Markers Initiative (PPMI) database. We assessed the baseline clinical features, apolipoprotein (APO) E status, β-glucocerebrosidase (GBA) mutation status, cerebrospinal fluid findings, and dopamine transporter imaging results. Using a diagnosis of CI (combined mild cognitive impairment and dementia) developed during the 5-year follow-up as outcome measures, we assessed the predictive values of baseline clinical variables and biomarkers. We also constructed a predictive model for the diagnosis of CI using logistic regression analysis. A total of 409 patients with NDPD with 5-year follow-up were enrolled, 232 with normal cognitive function at baseline, and 94 patients developed CI during the 5-year follow-up. In multivariate analyses, age, current diagnosis of hypertension, baseline MoCA scores, Movement disorder society Unified PD Rating Scale part III (MDS-UPDRS III) scores, and APOE status were associated with the development of CI. Predictive accuracy of CI using age alone improved by the addition of clinical variables and biomarkers (current diagnosis of hypertension, baseline MoCA scores, and MDS-UPDRS III scores, APOE status; AUC 0.80 [95% CI 0.74-0.86] vs. 0.71 [0.64-0.77], p = 0.008). Cognitive domains that had higher frequencies of impairment were found in verbal memory (12.6 vs. 16.8%) and attention/processing speed (12.7 vs. 16.9%), however, no significant difference in the prevalence of CI at annual follow-up was found during the 5-year follow-up in NDPD patients. In NDPD, the development of CI during the 5-year follow-up can be predicted with good accuracy using a model combining age, current diagnosis of hypertension, baseline MoCA scores, MDS-UPDRS III scores, and APOE status. Our study underscores the need for the earlier identification of CI in NDPD patients in our clinical practice.

Neurocognitive function in patients with atrial fibrillation undergoing pulmonary vein isolation.

Atrial fibrillation (AF) is associated with cognitive dysfunction. However, neurocognitive function in AF patients undergoing pulmonary vein isolation (PVI) has not been well studied. The aim of this analysis is to compare neurocognitive function in patients who did or did not undergo PVI. We used data from the Swiss Atrial Fibrillation Cohort study (Swiss-AF), a prospective, observational, multicenter study in Switzerland. Patients with documented AF were enrolled and data of 1,576 patients without history of PVI and with complete information on PVI status and neurocognitive function were used. Information on PVI was collected at baseline and during 1 year of follow-up. Neurocognitive testing was performed at baseline and after 1 year of follow-up, using the Montreal Cognitive Assessment (MoCA), trail making test (TMT) A and B, digit symbol substitution test (DSST) and semantic fluency test (SFT). To investigate the association of PVI with neurocognitive function, we use propensity score matching (1:3) and inverse probability of treatment weighting (IPTW). The mean age of this population was 74 ± 8 years, 27.1% were women. Overall, 88 (5.5%) patients underwent PVI during 1 year of follow-up. Using ITPW (n = 1576), PVI was weakly associated with the MoCA score after adjusting for time since PVI, baseline MoCA score and other covariates (β (95%CI) 1.19 (0.05; 2.32), p = 0.04). In the propensity matched comparison (n = 352), there was no significant association between PVI and the MoCA score (β (95%CI) 1.04 (-0.19; 2.28), p = 0.1). There were no significant associations between PVI and cognitive function when using the TMT A and B, DSST or SFT independent of the method used. In this population of AF patients, there was no consistent evidence of an association between PVI and neurocognitive function. [https://clinicaltrials.gov/], identifier [NCT02105844].

Cognitive recovery in patients with post-stroke subjective cognitive complaints.

Background and purposeThe objective cognitive trajectory in patients with post-stroke subjective cognitive complaints (SCC) over time remained unknown. We investigated cognitive outcomes in patients with SCC within 1 year after stroke, and determined factors associated with cognitive recovery.MethodsThis study included 599 patients with a clinical diagnosis of post-stroke SCC and evidence of cognitive deficits including Clinical Dementia Rating Scale (CDR) = 0.5, Montreal Cognitive Assessment (MoCA) score <26, and Mini–Mental State Examination score >17 (illiterate) or >20 (primary school) or >24 (junior school or above). Neuropsychological assessment was performed at baseline (2 weeks to 6 months after stroke) and 6-month follow-up visit. Cognitive recovery was operationalized as unimpaired cognition (MoCA score ≥26 and CDR = 0) after 6 months. Factors associated with recovery were defined through logistic regression analysis.ResultsAfter 6 months, 583 patients completed the follow-up with 80 (13.72%) presenting cognitive recovery, among which, 22 (9.48%) cases reported SCC within 2 weeks after stroke, six (10%) at 15–30 days, 13 (15.12%) at 31–60 days, 10 (16.13%) at 61–90 days, five (10.42%) at 91–120 days, nine (23.08%) at 121–150 days, and 15 (26.79%) at 151–180 days. Compared to those reported cognitive complaints at 151–180 days after stroke, patients with early post-stroke SCC had poorer cognitive recovery, which was only significant in individuals with high level of education. Male sex, higher baseline MoCA scores, coffee intake and thalamus lesions were independently associated with high chance of cognitive recovery.ConclusionsAlthough post-stroke SCC contributes to persisting objective cognitive deficits, some patients presented cognitive recovery within 1 year after stroke. Patients with a high education level reporting SCC at earlier stage after stroke had poorer cognitive recovery. Male, higher baseline MoCA scores, coffee intake and thalamus lesions appear to independently predict cognitive recovery.

Cannabis use and effect of cannabis abstinence on cognitive functioning in young people — an observational case-control follow-up study from rehabilitation centre in Andhra Pradesh

BackgroundCannabis is the most commonly used illicit substance globally, in India particularly. In recent times, younger people started abusing cannabis, resulting in academic decline and psychological disorders. Research from developed countries had shown that abstinence from cannabis reverses cognitive decline in the young population to a certain extent. Studies on this topic have been very few in India. We intended to assess the effects of cannabis use and abstinence from cannabis on the cognitive functioning of young adults.The study was an observational study including 50 consecutive young male patients, who got admitted to our rehabilitation centre with cannabis use disorder (group A). The Montreal Cognitive Assessment (MoCA) test was used to assess the baseline cognitive functioning of these patients initially after 1 week of abstinence and compared with 50 graduate students with no history of cannabis use (group B). The MoCA test was re-administered to group A subjects after 3 months of strict abstinence from cannabis use.ResultsThere was a statistically significant difference between the baseline MoCA score of cannabis users and the controls (P < 0.001). Both the duration (r = −0.296, P = 0.036) and the quantity (r= −0.491, P < 0.001) of cannabis use had a negative correlation with the MoCA score. When the MoCA test was re-administered after 3 months of abstinence, we found a statistically significant improvement in cognitive functioning in cannabis users (P < 0.001), but the mean score was still less than the mean score of the control group (24.08 ± 2.66 vs 28.62 ± 0.85, P < 0.001) showing only partial improvement.ConclusionThis study showed that cognitive deficits were seen in cannabis users as compared to nonusers. It also had shown that abstinence from cannabis had partially reversed the impairment, but still some deficits were remaining. There is an urgent need for primary prevention strategies at community level to decrease the prevalence of cannabis use.

Assessment and prediction of affective disorders in patients after cerebral stroke using modern measurement scales

Objective — to analyze the results of scale‑based assessments of post‑stroke depression (PSD) and post‑stroke anxiety disorders (PSAD) in different phases of cerebral stroke (CS) as well as to determine independent predictors of PSD at discharge from the Stroke Center (StC), and to evaluate the characteristics of the respective predictive models. Methods and subjects. Two hundred patients, including 92 (46.0 %) women and 108 (54.0 %) men with the median age of 65.6 years (IQR 58.2 — 75.1) were enrolled. The health status of all patients was assessed after hospitalization using the National Institutes of Health Stroke Scale (NIHSS), Barthel Index, Modified Rankin Scale, Mini‑Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA). 172 (86.0 %) patients were diagnosed with ischemic stroke (IS), 28 (14.0 %) — intracerebral hemorrhage. Among patients with IS, 58 (33.7 %) had an atherothrombotic subtype, 85 (49.4 %) had a cardioembolic subtype, 16 (9.3 %) had a lacunar subtype, 13 (7.6 %) had another or unknown subtype. The PSD and PSAD were assessed using the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire (PHQ‑9) before discharge from the Stroke Center. The impact of factors was assessed by odds ratio (OR) and its 95 % confidence interval (95 % CI). The method of constructing and analyzing logistic regression models was used to determine independent predictors of PSD at discharge. Results. The baseline NIHSS score ranged from 1 to 29. The mRS scores upon admission were from 1 to 5, and the BI scores from 0 to 100. Forty‑one (20.5 %) patients were admitted in the hyperacute period, 55 (27.5 %) in the acute period, 68 (34.0 %) in the early subacute period, 13 (6.5 %) in the late subacute period, and 23 (11.5 %) in the chronic phase of stroke. The HADS‑D score ranged from 0 to 18, and the HADS‑A score from 0 to 15. PHQ‑9 scores ranged from 0 to 21. Based on the HADS score, 19 (9.5 %) of the patients had clinically significant PSD and 16 (8.0 %) of the participants had clinically significant PSAD. According to the total HADS score, 22 (11.0 %) of the patients had clinically significant affective disorders. With PHQ‑9 showed that clinically significant PSD was detected in 45 (22.5 %) patients. The HADS and PHQ‑9 scores had a strong positive significant correlation, but neither of them correlated with the age or sex of the patients, the subtype or severity of CS. However, univariate analysis showed that the risk of clinically significant PSD at discharge (according to HADS‑D) was significantly directly related to age and atrial fibrillation in addition to inverse relationship with the BI, MMSE and MoCA scores, LA subtype of IS and ICH. The risk of moderate to severe PSD (according to PHQ‑9) had a statistically significant direct corelation with the initial NIHSS score, as well as an inverse corelation with the baseline BI, MMSE, and MoCA scores. In multivariate analysis, 4 features were independently associated with PSD (HADS‑D &gt; 10) at discharge: initial MMSE score (OR 0.93; 95 % CI 0.88 — 0.98, on average, for each additional point, p = 0.006), arterial hypertension (OR 8.5; 95 % CI 0.9 — 76.3; p = 0.057) or obesity (OR 0.23; 95 % CI 0.05 — 1.14; p = 0.072) as well as hospitalization after 30 days from CS onset. The predictive model based on these 4 variables had excellent sensitivity (94.7 %) and satisfactory specificity (73.3 %) and could assess the risk of developing PSD with good accuracy (AUC = 0.847). Furthermore, three factors were independent predictors of moderate or severe PSD (PHQ‑9 &gt; 9) at discharge: age (OR 1.04; 95 % CI 1.00 — 1.08, on average, for each additional year, p = 0.028), the baseline MoCA score (OR 0.94; 95 % CI 0.91 — 0.98, on average, with an increase in the score for each additional point, p = 0.005) and UN subtype of IS. The prognostic model based on the latter 3 variables had satisfactory sensitivity (65.1 %) and specificity (75.5 %), but good accuracy of PSD prediction (AUC = 0.735). Conclusions. The HADS and PHQ‑9 scores in CS patients varied widely, and indicated high prevalence of clinically significant PSD and PSAD. HADS and PHQ‑9 scores correlated with each other, but not with age, sex, subtype, or severity of stroke. Elderly patients with significant cognitive impairment on admission were at a higher risk of affective disorders. The prognostic models allow accurate PSD prediction, which can contribute to the timely detection and initiation of PSD treatment in patients at risk.

Effect of Intensive Blood Pressure Control on Incident Stroke Risk in Patients With Mild Cognitive Impairment.

Patients with mild cognitive impairment may be at higher risk of incident stroke, but the effect of intensive blood pressure (BP) control on that risk has not been explored. We performed a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial) and included patients with a baseline Montreal Cognitive Assessment score of 19 to 25 and without a prior history of stroke. The primary outcome was incident stroke (ischemic and hemorrhagic) during follow-up. We report the unadjusted cumulative risk of our primary outcome by SPRINT randomization arm (intensive versus standard BP control) and also fit Cox models to the primary outcome and adjusted for patient age at randomization, race/ethnicity, sex, baseline BP, atrial fibrillation, diabetes, and smoking. We included 5091 patients (mean age 68.2, 44% female, 56.7% non-Hispanic White, and 50.2% randomized to intensive BP control), of which 95/5091 (1.9%) had an incident stroke during a mean of 3.8±0.9 years of follow-up. The risk of incident stroke in patients randomized to standard BP control was 57/2536 (2.3%) and to intensive BP control was 38/2555 (1.5%; P=0.045). In the adjusted Cox model, the hazard ratio for incident stroke events with intensive BP control was 0.65 (95% CI, 0.43-0.98; P=0.040). Although the SPRINT trial failed to show a reduction in stroke with intensive BP control for all subjects, those with a Montreal Cognitive Assessment score consistent with mild cognitive impairment at baseline had an association between intensive BP control and lower risk of incident stroke. Future trials of primary prevention of stroke may benefit from enrichment using baseline vascular biomarkers of elevated risk, such as mild cognitive impairment.

African-American Race Predicts 1-Year Cognitive Decline Among Adults Without Moderate Dementia

Previous literature shows conflicting conclusions about the association between race and cognitive decline, particularly in early impairment. In this study, we aimed to test whether race predicted 1-year change in Montreal Cognitive Assessment (MoCA) score among older adults without moderate-severe dementia. We secondarily explored whether multimorbidity, polypharmacy, depressed mood, antidepressant use, body composition, or frailty changed the association. We analyzed data (n=122) from predominantly African American (AfA, 78.7%) community-dwelling older adults from the south side of Chicago. Participants underwent baseline and 1-year MoCA testing. Age, gender, race, education, monthly income, co-morbidities (Charlson Comorbidity Index), medication use (<5 vs ≥5), depression (PHQ-2), proportion lean mass (DEXA), and the frailty phenotype (range 0-5) were collected at baseline. In a multivariate linear model, we regressed 1-year MoCA score on baseline MoCA score, race, and demographics and then evaluated the impact of each covariate added separately to the model on the race-cognition relationship. The mean MoCA score at baseline was 25.2+/-0.2 (range 18-30) and 41.0% of participants experienced ≥1 point MoCA decline at 1 year. After adjusting for demographics, AfAs experienced a greater 1-year MoCA decline (β= -1.3, p=0.04) compared to other races. The effect size was unchanged after adjusting for multimorbidity and polypharmacy (β= -1.3, p=0.04), attenuated slightly after adjusting for frailty (β= -1.2, p=0.06), depressed mood (β= -1.2, p=0.05), lean mass (β= -1.2, p=0.04), and attenuated notably after adjusting for antidepressant use (β= -1.0, p=0.11). Findings support the need to further explore racial differences in cognitive decline and potentially related anti-depressant underuse.